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Ali-Hasan-Al-Saegh S, Takemoto S, Shafiei S, Yavuz S, Arjomandi Rad A, Amanov L, Merzah AS, Salman J, Ius F, Kaufeld T, Schmack B, Popov AF, Sabashnikov A, Ruhparwar A, Zubarevich A, Weymann A. Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures-A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions. J Clin Med 2024; 13:4887. [PMID: 39201028 PMCID: PMC11355092 DOI: 10.3390/jcm13164887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Sho Takemoto
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Saeed Shafiei
- Department of Cardiac and Thoracic Vascular Surgery, Marburg University Hospital, 35043 Marburg, Germany
| | - Senol Yavuz
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey
| | | | - Lukman Amanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Bastian Schmack
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield UB9 6JH, UK
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
| | - Alexander Weymann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (A.W.)
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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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Takaseya T, Itaya N, Sasaki KI, Sasaki M, Yokomizo M, Honda A, Oshita K, Azuma J, Fukumoto Y, Tayama E. Cusp overlap technique decreases paravalvular leakage in self-expandable transcatheter aortic valve replacement. Heart Vessels 2024; 39:48-56. [PMID: 37606754 DOI: 10.1007/s00380-023-02307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
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Affiliation(s)
- Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Masahiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Kensuke Oshita
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Junpei Azuma
- Division of Radiology, Kurume University Hospital, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan
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Muneretto C, Di Bacco L, Pollari F, Baudo M, Solinas M, D'Alonzo M, Di Eusanio M, Rosati F, Folliguet T, Fischlein T. Sutureless versus transcatheter valves in patients with aortic stenosis at intermediate risk: A multi-institutional European study. Surgery 2023; 174:1153-1160. [PMID: 37714757 DOI: 10.1016/j.surg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Recent randomized controlled trials showed comparable short-term outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in intermediate and low-risk patients. However, independent studies comparing transcatheter aortic valve implantation results versus surgical aortic valve replacement at 5 years showed worsening outcomes in patients treated with transcatheter aortic valve implantation. The aim of this study was to analyze mid- to long-term outcomes of patients with isolated aortic stenosis and an intermediate-risk profile who underwent aortic valve replacement using a sutureless valve versus transcatheter aortic valve implantation. METHODS This retrospective multi-institutional European study investigated 2,123 consecutive patients with isolated aortic stenosis at intermediate risk profile treated with sutureless aortic valve replacement (824 patients) or transcatheter aortic valve implantation (1,299 patients) from 2013 to 2020. After 1:1 propensity score matching, 2 balanced groups of 517 patients were obtained. Primary endpoints were as follows: 30 days, late all-cause, and cardiac-related mortality. Secondary endpoints included major adverse cardiocerebrovascular events (all-cause death, stroke/transient ischemic attack, endocarditis, reoperation, permanent pacemaker implantation, and paravalvular leak grade ≥2). RESULTS Median follow-up was 4.3 years (interquartile range 1.1-7.4 years). Primary endpoints were as follows-30-day mortality sutureless aortic valve replacement: 2.13% versus transcatheter aortic valve implantation: 4.64% (P = .026), all-cause mortality sutureless aortic valve replacement: 36.7% ± 7.8% vs transcatheter aortic valve implantation: 41.8% ± 8.2% (P = .023), and cardiac-related mortality sutureless aortic valve replacement: 10.2% ± 2.8% vs transcatheter aortic valve implantation: 19.2% ± 3.5%;(P = .00043) at follow-up. Secondary endpoints were as follows-major adverse cardiocerebrovascular events in the sutureless aortic valve replacement group: 47.2% ± 9.0% versus transcatheter aortic valve implantation: 57.3% ± 7.5% (P < .001). In particular, the incidence of permanent pacemaker implantation (sutureless aortic valve replacement: 6.38% versus transcatheter aortic valve implantation: 11.8% [P = .002]) and paravalvular leak ≥2 (sutureless aortic valve replacement: 0.97% versus transcatheter aortic valve implantation: 4.84% [P = .001]) was significantly higher in transcatheter aortic valve implantation group. At Multivariable Cox regression analysis, paravalvular leak ≥2 (hazard ratio: 1.63%; 95% confidence interval: 1.06-2.53, P = .042) and permanent pacemaker implantation (hazard ratio: 1.49%; 95% confidence interval: 1.02-2.20, P = .039) were identified as predictors of mortality. CONCLUSION Sutureless aortic valve replacement showed a significantly lower incidence of all-cause mortality, cardiac-related death, permanent pacemaker implantation, and paravalvular leak than transcatheter aortic valve implantation. Moreover, permanent pacemaker implantation and paravalvular leak negatively affected survival in patients treated for isolated aortic stenosis.
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Affiliation(s)
- Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Francesco Pollari
- Universitaets Klinik der Paracelsus Medizinischen Privatuniversitaet, Nuremberg, Germany
| | - Massimo Baudo
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | | | - Michele D'Alonzo
- Division of Cardiac Surgery, University of Brescia Medical School, Italy.
| | - Marco Di Eusanio
- Cardiac Surgery, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Italy
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor Hospital, AP-HP, University Paris Est Créteil, France
| | - Theodor Fischlein
- Universitaets Klinik der Paracelsus Medizinischen Privatuniversitaet, Nuremberg, Germany
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5
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Dokollari A, Torregrossa G, Bisleri G, Hassanabad AF, Sa MP, Sicouri S, Veshti A, Prifti E, Bacchi B, Cabrucci F, Ramlawi B, Bonacchi M. Early and Long-Term Clinical and Echocardiographic Outcomes of Sutureless vs. Sutured Bioprosthesis for Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050224. [PMID: 37233191 DOI: 10.3390/jcdd10050224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1-19.4% vs. SB 0-1%), PPI (Perceval 2-10.7% vs. SB 1.8-8.5%), and MI (Perceval 0-7.8% vs. SB 0-4.3%) were comparable. In addition, the stroke rate was lower in the SU-AVR group when compared to SB (Perceval 0-3.7% vs. SB 1.8-7.3%). In patients with a bicuspid aortic valve, the mortality rate was 0-4% and PVL incidence was 0-2.3%. Long-term survival ranged between 96.7 and 98.6%. Valve cost analysis was lower for the Perceval valve and higher for sutured bioprosthesis. Conclusions: Compared to SB valves, Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its non-inferior hemodynamics, implantation speed, reduced cardiopulmonary bypass time, reduced aortic cross-clamp time, and shorter length of stay.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | | | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
| | - Michel Pompeu Sa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Altin Veshti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Edvin Prifti
- Cardiac Surgery Department, Mother Teresa Hospital, University of Tirana, 1000 Tirana, Albania
| | - Beatrice Bacchi
- St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Cabrucci
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA 19096, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Massimo Bonacchi
- F.U. Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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Öner A, Hemmer C, Alozie A, Löser B, Dohmen PM. Introduction of the Rapid Deployment Aortic Valve System Use in Elderly Patients With Endocarditis. Front Cardiovasc Med 2022; 9:774189. [PMID: 35391848 PMCID: PMC8980357 DOI: 10.3389/fcvm.2022.774189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The rapid-deployment valve system (RDVS) was introduced to facility minimally invasive aortic valve replacement. In this study we evaluate the potential benefits of RDVS in elderly high-risk patients with endocarditis of the aortic valve. Materials and Methods Since the introduction of RDVS in our institution in December 2017 through October 2021, EDWARDS INTUITY rapid-deployment prosthesis (Model 8300A, Edwards Lifesciences, Irvine, CA, USA) has been implanted in a total of 115 patients for different indications by a single surgeon. Out of one-hundred and fifteen cases of RDVS implantation, seven patients with a median age of 77 yrs. (range 62-84yrs.), suffered from active infective endocarditis of the aortic valve. The median EuroSCORE II of these highly selected patient cohort was 77% (range 19-80%). Patient data were evaluated perioperatively including intra-operative data as well as in-hospital morbidity/mortality and follow-up after discharge from hospital. Results Three patients underwent previous cardiac surgery. Concomitant procedures were performed in six patients including, ascending aorta replacement (n = 3), mitral valve repair (n = 1), pulmonary valve replacement (n = 1), bypass surgery (n = 1), left atrial appendix resection (n = 1) and anterior mitral valve repair (n = 1). Median aortic cross-clamp and cardiopulmonary bypass time was 56 min (range 29-122 min) and 81 min (range 45-162 min.), respectively. Post-operative complications in these elderly high-risk patients were atrial fibrillation (n = 3) and re-exploration for pericardial effusion (n = 1). One pacemaker implantation was required on postoperative day 6 due to sick sinus syndrome. There was one in-hospital death (14%) and one during follow-up (14%). Conclusion Rapid-deployment aortic valve system seems to be a viable option with acceptable morbidity and mortality in elderly high-risk patients with active infective endocarditis of the aortic valve.
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Affiliation(s)
- Alper Öner
- Department of Cardiology, Heart Center Rostock, University of Rostock, Rostock, Germany
| | - Christoph Hemmer
- Department of Tropical Medicine and Infectious Diseases, University of Rostock, Rostock, Germany
| | - Anthony Alozie
- Department of Cardiac Surgery, Heart Center Rostock, University of Rostock, Rostock, Germany
| | - Benjamin Löser
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - Pascal M. Dohmen
- Department of Cardiac Surgery, Heart Center Rostock, University of Rostock, Rostock, Germany
- Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
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7
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Dokollari A, Ramlawi B, Torregrossa G, Sá MP, Sicouri S, Prifti E, Gelsomino S, Bonacchi M. Benefits and Pitfalls of the Perceval Sutureless Bioprosthesis. Front Cardiovasc Med 2022; 8:789392. [PMID: 35071358 PMCID: PMC8766961 DOI: 10.3389/fcvm.2021.789392] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To highlight the main target points covered by clinical studies on the Perceval sutureless valve for surgical aortic valve replacement (SAVR) and raise a point of discussion for further expansion of its use when compared with stented bioprostheses (SB) and transcatheter aortic valve replacement (TAVR). Methods: We reviewed clinical trials and retrospective studies published up to date and compared the outcomes in terms of mortality, myocardial infarction (MI) stroke, paravalvular leak (PVL), permanent pacemaker implantation (PPI), bleeding and long-term outcomes. Results: Clinical studies showed that 30-day mortality ranged from 0–4% for Perceval and 2.9–7% for TAVR. The incidence of PVL (Perceval 1.9–19.4 vs. TAVR 9–53.5%), PPI (Perceval 2–11.2 vs. TAVR 4.9–25.5%), stroke (Perceval 0 vs. TAVR 0–2.8%), MI (Perceval 0 vs. TAVR 0–3.5%), were all higher in the TAVR group. Compared to other SB, mortality ranged from 0–6.4% for Perceval and 0–5.9% for SB. The incidence of PVR (Perceval 1–19.4 vs. SB 0–1%), PPI (Perceval 2–10.7 vs. SB 1.8–8.5%), stroke (Perceval 0–3.7 vs. SB 1.8–7.3%) and MI (Perceval 0–7.8 vs. SB 0–4.3%) were comparable among the groups. In patients with a bicuspid aortic valve, mortality rate was (0–4%) and PVL incidence was (0–2.3%). However, there was a high incidence of PPI (0–20%), and stroke (0–8%). Long-term survival ranged between 96.7–98.6%. Conclusions: The Perceval bioprosthesis has proved to be a reliable prosthesis for surgical aortic valve replacement due to its implantation speed, the reduced cardiopulmonary bypass time, the reduced aortic cross-clamp time and the shorter intensive care unit and hospital length of stay.
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Affiliation(s)
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Serge Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, United States.,Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Edvin Prifti
- Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Sandro Gelsomino
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Maastricht, Netherlands
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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8
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Kim KS, Makhdoum A, Koziarz A, Gupta S, Alsagheir A, Pandey A, Reza S, Um K, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Côté EP, Whitlock RP. Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis. J Card Surg 2021; 36:4734-4742. [PMID: 34617322 DOI: 10.1111/jocs.16044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. METHODS We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. RESULTS We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. CONCLUSION Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.
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Affiliation(s)
- Kevin S Kim
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ahmad Makhdoum
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Koziarz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arjun Pandey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Seleman Reza
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Kevin Um
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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9
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Bejko J, Della Barbera M, Valente M, Pettenazzo E, Gregori D, Basso C, Thiene G. Morphologic investigation on Perceval S, a sutureless pericardial valve prosthesis: collagen integrity after collapsing-ballooning and structural valve deterioration at distance. Int J Cardiol 2021; 341:62-67. [PMID: 34324948 DOI: 10.1016/j.ijcard.2021.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Perceval S is a self-expandable, stent-mounted bioprosthetic valve (BPV), with glutaraldehyde treated bovine pericardium, processed with homocysteic acid as an anti-calcification treatment. The stent is crimpable but the valve insertion is done surgically via a shorter procedure which does not require sutures. OBJECTIVES: MATERIAL AND METHODS: RESULTS: CONCLUSIONS: Collapsing and ballooning do not alter cusp collagen periodicity. Structural valve deterioration with stenosis, due to dystrophic calcification and fibrous tissue overgrowth, seldom occurred in the mid-term. Glutaraldehyde fixed pericardium has the potential to undergo structural valve deterioration with time, similar to well-known BPV failure. This supports the recommendation to pursue improvement of tissue valve treatment with enhanced durability.
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Affiliation(s)
- Jonida Bejko
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Mila Della Barbera
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy.
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10
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Papakonstantinou NA, Baikoussis NG, Dedeilias P. Perceval S valve empire: healing the Achilles' heel of sutureless aortic valves. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:625-631. [PMID: 34014059 DOI: 10.23736/s0021-9509.21.11608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve replacement is the treatment of choice concerning aortic valve disease. Excellent short- and longterm clinical results are reported. Patients referred for aortic valve replacement are getting older and older, so bioprosthetic valves play a more central role worldwide. However, patient comorbidities are also increased more often rendering patients unsuitable for open conventional aortic valve replacement. As a result, transcatheter aortic valve implantation has become the treatment of choice in patients at very high surgical risk. However, the percutaneous technique is related to major disadvantages provided that the diseased native valve is left in place. Its durability is also uncertain. More recently, sutureless Perceval S valve bioprosthesis has gained ground in the field of aortic stenosis therapy filling the gap between conventional aortic valve replacement and transcatheter approach. Excellent haemodynamic and clinical results are reported. Its deployment is performed under direct view and ischemic and overall operative times are significantly decreased. Five-year follow-up results are also optimal. However, the "Achilles' heel" of sutureless technology is increased rates of postoperative permanent pacemaker implantation requirement compared to conventional approach. The incidence of this complication varies in literature. Patient-related factors such as preoperative conduction disorders, older age and short membranous septum are predictors of postoperative pacemaker requirement. However, several technical modifications with regard to manufacturer recommendations can be adopted to mitigate this complication. Appropriate annular decalcification, higher guiding sutures placement, reduced balloon pressure and duration and avoiding of oversizing can contribute to prevent from this complication.
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Affiliation(s)
| | | | - Panagiotis Dedeilias
- Cardiothoracic Surgery Department, General Hospital of Athens Evangelismos', Athens, Greece
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11
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Di Bacco L, Rosati F, Folliguet T, Petruccelli RD, Concistrè G, Santarpino G, Di Bartolomeo R, Bisleri G, Fischlein TJ, Muneretto C. Sutureless aortic valves in elderly patients with aortic stenosis and intermediate-risk profile. J Cardiovasc Med (Hagerstown) 2021; 22:297-304. [PMID: 33633045 DOI: 10.2459/jcm.0000000000001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Sutureless valves became an alternative to standard bioprostheses, allowing surgeons to significantly reduce cross-clamping and extracorporeal circulation times, with a potential positive impact on major postoperative complications. The aim of this European multicentre study was to evaluate the safety and efficacy of sutureless valves in patients with an intermediate-risk profile undergoing aortic valve replacement (AVR). METHODS We investigated early and mid-term outcomes of 518 elderly patients with aortic stenosis at intermediate-risk profile (mean STS Score 6.1 ± 2%) undergoing AVR with sutureless aortic valve. Primary endpoints were 30-day mortality and freedom from all-cause death at follow-up. The secondary endpoint was survival freedom from MACCEs [all-cause death, stroke/transitory ischemic attack (TIA), bleeding, myocardial infarction, aortic regurgitation Grade II, endocarditis, reintervention and pacemaker implant; VARC 1--2 criteria]. RESULTS Sutureless valve implantation was successfully performed in 508 patients, with a procedural success rate of 98.1% (508/518) as per VARC criteria. Concomitant myocardial revascularization [coronary artery bypass grafting (CABG)] was performed in 74 out of 518 patients (14.3%). In-hospital mortality was 1.9% (10/518). Postoperative complications included revision for bleeding (23/518; 4.4%), prolonged intubation more than 48h (4/518; 0.7%), acute renal failure (14/518; 2.7%), stroke/TIA (11/518; 2.1%), pacemaker implantation (26/518; 5.1%) and aortic regurgitation more than Grade II (7/518; 1.4%). At 48-month follow-up, Kaplan-Meier overall survival and freedom from MACCEs in patients receiving isolated AVR were 83.7% [95% confidence interval (95% CI): 81.1-86.3] and 78.4% (95% CI: 75.5-81.4), respectively, while in patients with concomitant CABG, Kaplan-Meier overall survival and freedom from MACCEs were 82.3% (95% CI: 73.3-91.3) and 79.1% (95% CI: 69.9-88.3), respectively. CONCLUSION The use of sutureless aortic valves in elderly patients with an intermediate-risk profile provided excellent early and mid-term outcomes, providing a reliable tool in patients undergoing surgical AVR in this specific subset of population. These preliminary data need to be investigated with a TAVI control-group in further studies.
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Affiliation(s)
- Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Rocco D Petruccelli
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
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12
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Gerfer S, Mauri V, Kuhn E, Adam M, Eghbalzadeh K, Djordjevic I, Ivanov B, Gaisendrees C, Frerker C, Schmidt T, Mader N, Rudolph T, Baldus S, Liakopoulos O, Wahlers T. Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF. Thorac Cardiovasc Surg 2021; 69:420-427. [PMID: 33761569 DOI: 10.1055/s-0040-1722692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE neo/TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort. METHODS A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes. RESULTS Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, p = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, p = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, p = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, p = 0.752). However, higher numbers of PVL (mild-PER = 0.0% vs. NEO = 55.9%, p = 0.001; moderate or higher-PER = 0.0% vs. NEO = 6.8%, p = 0.119) after TAVI with NEO were observed. CONCLUSION Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christopher Gaisendrees
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christian Frerker
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Tobias Schmidt
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany.,Department of Cardiology/Angiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University Bochum, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany.,Department of Cardiac Surgery, Campus Kerckhoff, University of Giessen, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
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13
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Muneretto C, Solinas M, Folliguet T, Di Bartolomeo R, Repossini A, Laborde F, Rambaldini M, Santarpino G, Di Bacco L, Fischlein T. Sutureless versus transcatheter aortic valves in elderly patients with aortic stenosis at intermediate risk: A multi-institutional study. J Thorac Cardiovasc Surg 2020; 163:925-935.e5. [DOI: 10.1016/j.jtcvs.2020.04.179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022]
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14
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Amer M, Al Jawad MA, Omar A, Metwaly H. Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic Valves in Patients With Aortic Stenosis: A Meta-Analysis. Heart Lung Circ 2020; 29:1301-1309. [PMID: 32354587 DOI: 10.1016/j.hlc.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/23/2020] [Accepted: 02/15/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Suture-less aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross-clamp time, which is an independent predictor of postoperative outcomes, especially in patients with serious comorbidities. By reducing the number of sutures, the time for suture placement is reduced. Our meta-analysis tried to assess the safety and haemodynamic performance of the suture-less aortic valve prostheses to ascertain their benefits as a viable alternative to current established measures. METHOD From their inceptions to February 2017, six electronic databases were searched. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognised. Based on the predefined endpoints, data were collected and analysed. RESULTS For incorporation in qualitative and quantitative analyses, 24 studies were recognised, with a total number of 5,073 patients undergoing suture-less aortic valve replacement. Mortality incidence at the 30-day and 12-month follow-ups were 2.5% and 2.7%, respectively, while the incidences of thromboembolic events (1.6%) and paravalvular leak (0.5%) were acceptable. CONCLUSIONS Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory haemodynamic performance.
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Affiliation(s)
| | - Mohammed Abd Al Jawad
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ahmed Omar
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Metwaly
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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15
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Abstract
Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center Al Hassa, Prince Fawaz bin Abdulaziz St., Hofuf city, 31982, Saudi Arabia
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
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16
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Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical Aortic Valve Replacement. J Interv Cardiol 2019; 2019:3537256. [PMID: 31772526 PMCID: PMC6739771 DOI: 10.1155/2019/3537256] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of aortic valve replacement. However, comparative on the incidence of (AKI) following transcatheter (TAVR) versus surgical valve replacement (SAVR) is sparse. Methods We performed a meta-analysis of the randomized controlled trials (RCT) and propensity-matched observational studies comparing (A) incidence of AKI and (B) incidence of dialysis-requiring AKI at 30 days after TAVR and SAVR. Results Twenty-six studies (20 propensity-matched studies; 6 RCTs) including 19,954 patients were analyzed. The incidence of AKI was lower after TAVR than after SAVR (7.1% vs. 12.1%, OR 0.52; 95%CI, 0.39-0.68; p<0.001, I2=57%), but the incidence of dialysis-requiring AKI was similar (2.8% vs. 4.1%, OR 0.78; 95%CI, 0.49-1.25; p=0.31, I2=70%). Similar results were observed in a sensitivity analysis including RCTs only for both AKI ([5 RCTs; 5,418 patients], 2.0% vs. 5.0%, OR 0.39; 95%CI, 0.28-0.53; p<0.001, I2=0%), and dialysis-requiring AKI ([2 RCTs; 769 patients]; 2.9% vs. 2.6%, OR 1.1; 95%CI, 0.47-2.58; p=0.83, I2=0%). However, in studies including low-intermediate risk patients only, TAVR was associated with lower incidence of AKI ([10 studies; 6,510 patients], 7.6% vs. 12.4%, OR 0.55, 95%CI 0.39-0.77, p<0.001, I2=57%), and dialysis-requiring AKI, ([10 studies; 12,034 patients], 2.0% vs. 3.6%, OR 0.57, 95%CI 0.38-0.85, p=0.005, I2=23%). Conclusions TAVR is associated with better renal outcomes at 30 days in comparison with SAVR, especially in patients at low-intermediate surgical risk. Further studies are needed to assess the impact of AKI on long-term outcomes of patients undergoing TAVR and SAVR.
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17
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Lloyd D, Luc JGY, Indja BE, Leung V, Wang N, Phan K. Transcatheter, sutureless and conventional aortic-valve replacement: a network meta-analysis of 16,432 patients. J Thorac Dis 2019; 11:188-199. [PMID: 30863588 DOI: 10.21037/jtd.2018.12.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally invasive surgical techniques pose alternatives to conventional surgery for the treatment of aortic stenosis (AS). We present a Bayesian network analysis comparing Valve Academic Research Consortium-2 clinical outcomes between transcatheter aortic valve implantation (TAVI), sutureless (SL-AVR) and conventional aortic valve replacement (CAVR). Methods Electronic searches of databases were conducted and seven two-arm randomized-controlled trials and 25 propensity-score-matched studies comparing clinical outcomes of TAVI, SL-AVR and CAVR for treatment of AS were identified. Bayesian Markov chain Monte Carlo modelling was used to analyze clinical outcomes. Results The analysis included 16,432 patients who underwent TAVI [7,056], SL-AVR [1,238] or CAVR [8,138]. Compared to CAVR, TAVI and SL-AVR were associated with reduced postoperative major bleeding of 59% (OR 0.41, 95% CI: 0.28-0.59) and 44% (OR 0.56, 95% CI: 0.30-0.99) respectively. TAVI had a 41% reduction in postoperative myocardial infarction (OR 0.59, 95% CI: 0.40-0.86) and SL-AVR had a 40% reduction in postoperative acute kidney injury (AKI) (OR 0.62, 95% CI: 0.42-0.86). Compared to TAVI, CAVR and SL-AVR had a reduction in moderate/severe paravalvular regurgitation of 89% (OR 0.11, 95% CI: 0.07-0.16) and 92% (OR 0.08, 95% CI: 0.03-0.17). CAVR had a 67% decreased postoperative permanent pacemaker (PPM) implantation compared to TAVI (OR 0.33, 95% CI: 0.24-0.45) and a 63% reduction compared to SL-AVR (OR 0.37, 95% CI: 0.22-0.61). There were no differences in 30-day mortality or postoperative stroke between the groups. Conclusions In selected patients, minimally invasive surgical interventions including TAVI and SL-AVR for severe AS are viable alternatives to conventional surgery. However, TAVI is associated with increased paravalvular regurgitation, whereas TAVI and SL-AVR are associated with increased conduction disturbances compared to CAVR.
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Affiliation(s)
- Declan Lloyd
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Elias Indja
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Vannessa Leung
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nelson Wang
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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18
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Lazkani M, Yerasi C, Prakash S, Pershad A, Fang K. Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations. J Card Surg 2018; 33:808-817. [DOI: 10.1111/jocs.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamad Lazkani
- University of Colorado HealthMedical Center of the RockiesLovelandColorado
| | | | - Sheena Prakash
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Ashish Pershad
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Kenith Fang
- University of ArizonaBanner University Medical CenterPhoenixArizona
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19
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Filip G, Litwinowicz R, Kapelak B, Piatek J, Bartus M, Konstanty-Kalandyk J, Brzezinski M, Bartus K. Mid-term follow-up after suture-less aortic heart valve implantation. J Thorac Dis 2018; 10:6128-6136. [PMID: 30622784 DOI: 10.21037/jtd.2018.10.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. Methods The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. Results After the SU-AVR procedure, the average peak/mean aortic gradients were respectively: 12.9/7.1 mmHg at the intraoperative time; 18.1/9.5 mmHg at 3-6 months; 18.3/9.6 mmHg at 11-14 months; 16.9/9.3 mmHg at 2 years; 15.3/8 mmHg at 3 years; 13.4/7.1 mmHg at 4 years; 16.7/8.9 mmHg at 5 years follow-up. Other hemodynamic echocardiographic parameters such as LVOT diameter, LVOT peak velocity, LVOT TVI, valve peak velocity and valve TVI were stable during the follow-up period. Conclusions In summary, sutureless bioprostheses are safe and effective treatments for valve stenosis with excellent outcomes and hemodynamic profile which remained stable during the follow-up period. The peak and mean gradients were 16.7 and 8.9 mmHg, respectively, over a 5-year follow-up period.
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Affiliation(s)
- Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Jacek Piatek
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Magdalena Bartus
- Department of Experimental Pharmacology, Jagiellonian University, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maciej Brzezinski
- Department of Cardiac and Vacsular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
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Shah K, Chaker Z, Busu T, Badhwar V, Alqahtani F, Alvi M, Adcock A, Alkhouli M. Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement. Am J Cardiol 2018; 122:1215-1221. [PMID: 30089530 DOI: 10.1016/j.amjcard.2018.06.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Stroke is one of the most feared complications of aortic valve replacement. Although the outcomes of transcatheter aortic valve implantation (TAVI) improved substantially over time, concerns remained about a potentially higher incidence of stroke with TAVI compared with surgical replacement (SAVR). However, comparative data are sparse. We performed a meta-analysis comparing the incidence of stroke among patients undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studies and 6 randomized trials) were analyzed. Primary endpoints were 30-day stroke and disabling stroke. Secondary endpoints were 1-year stroke and disabling stroke. A total of 23,587 patients were included, of whom 47.27% underwent TAVI and 52.72% underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR) with 95% confidence interval (CI) were calculated. The pooled estimates for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were comparable following TAVI versus SAVR at 30 days. Similarly, the pooled estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96) and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71) were similar at 1 year. A sensitivity analysis including only RCTs yielded similar results. Our meta-analysis documents comparable rates of strokes and disabling strokes following TAVI or SAVR both at 30 days and 1 year.
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Affiliation(s)
- Kuldeep Shah
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV
| | - Zakeih Chaker
- Department of Medicine, West Virginia School of Medicine, Morgantown, WV
| | - Tatiana Busu
- Department of Medicine, West Virginia School of Medicine, Morgantown, WV
| | - Vinay Badhwar
- Department of Cardiothoracic Surgery, West Virginia School of Medicine, Morgantown, WV
| | - Fahad Alqahtani
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV
| | - Muhammad Alvi
- Department of Neurology, West Virginia School of Medicine, Morgantown, WV
| | - Amelia Adcock
- Department of Neurology, West Virginia School of Medicine, Morgantown, WV
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV.
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21
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Shinn SH, Altarabsheh SE, Deo SV, Sabik JH, Markowitz AH, Park SJ. A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2018; 106:924-929. [PMID: 29709503 DOI: 10.1016/j.athoracsur.2018.03.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Sung Ho Shinn
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Republic of Korea.
| | - Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Joseph H Sabik
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Soon J Park
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
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Chauvette V, Mazine A, Bouchard D. Ten-year experience with the Perceval S sutureless prosthesis: lessons learned and future perspectives. J Vis Surg 2018; 4:87. [PMID: 29963376 DOI: 10.21037/jovs.2018.03.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/26/2022]
Abstract
Aortic stenosis has traditionally been addressed with surgical aortic valve replacement (AVR). In recent years, several technologies have emerged as alternative treatment methods for aortic valve disease. Among them, the Perceval (LivaNova, London, UK) is a sutureless valve that has been used in clinical practice for over 10 years. It has been implanted in over 20,000 patients worldwide. With nearly 600 Perceval implants since 2011, the Montreal Heart Institute has developed a worldwide expertise with this technology. In this article, we provide an overview of the clinical data currently available in the literature and discuss the lessons we have learned from our experience with the Perceval prosthesis.
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Affiliation(s)
- Vincent Chauvette
- Division of Cardiac Surgery, University of Montreal, Montreal, QC, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Denis Bouchard
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada
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23
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The Perceval Sutureless Aortic Valve: Review of Outcomes, Complications, and Future Direction. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:155-173. [PMID: 28570342 DOI: 10.1097/imi.0000000000000372] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Surgical aortic valve replacement with a stented prosthesis has been the standard of care procedure for aortic stenosis. The Perceval (LivaNova, London, United Kingdom) is a sutureless aortic valve bioprosthesis currently implanted in more than 20,000 patients. The purpose of this article was to review the literature available after 9 years of clinical experience of the Perceval aortic valve. PubMED, Embase, and the Cochrane Library databases were searched. A meta-analysis of summary statistics from individual studies was conducted. A total of 333 studies were identified and 84 studies were included. Thirty-day mortality and 5-year survival ranged from 0% to 4.9% and 71.3% to 85.5%, respectively. Compared with stented prosthesis, pooled analysis demonstrated a statistically significant reduction in aortic cross-clamp and cardiopulmonary bypass times (minutes) with Perceval (38.6 vs 63.3 and 61.4 vs 84.9, P < 0.00001, respectively). Compared with transcatheter aortic valve implantation, pooled analysis demonstrated a statistically significant reduction with Perceval in paravalvular leakage (1.26% vs 14.31%) and early mortality (2.3% vs 6.9%). Favorable hemodynamics, acceptable valve durability, and ease of implantation in minimally invasive cases were reported as benefits. A trend toward increased rates of permanent pacemaker implantation and low postoperative platelet count were identified. Special use and off-label procedures described included bicuspid aortic valves, valve-in-valve for homograft and stentless prosthesis failure, concomitant valvular procedures, porcelain aorta, and endocarditis. The Perceval valve has shown safe clinical and hemodynamic outcomes. Outcomes support its continued usage and potential expansion.
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Garrido JM, Cánovas S, Cuenca J, Barquero JM, Silva J, Araji O, Gómez MÁ, Castellá M, Hornero F, Centella T. Abordaje integral de la valvulopatía aórtica. Implante transcatéter de válvula aórtica. Posición y recomendaciones de la Sociedad Española de Cirugía Torácica y Cardiovascular. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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25
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Onorati F, Gherli R, Mariscalco G, Girdauskas E, Quintana E, Santini F, De Feo M, Sponga S, Tozzi P, Bashir M, Perrotti A, Pappalardo A, Ruggieri VG, Santarpino G, Rinaldi M, Ronaldo S, Nicolini F. Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: study protocol of a prospective multicentre European registry (E-AVR registry). BMJ Open 2018; 8:e018036. [PMID: 29440154 PMCID: PMC5829669 DOI: 10.1136/bmjopen-2017-018036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both 'sutured' and 'sutureless' valves) will provide a 'real-world' picture of available results of current surgical options and will help to clarify the 'grey zones' of current guidelines. METHODS AND ANALYSIS European Aortic Valve Registry is a prospective observational open registry designed to collect all data from patients admitted for SAVS, with or without coronary artery disease, in 16 cardiac surgery centres located in six countries (France, Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over a 2-year period and followed up for a minimum of 5 years to a maximum of 10 years after enrolment. Outcome definitions are concordant with Valve Academic Research Consortium-2 criteria and established guidelines. Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at establishing 'early' 30-day all-cause and cardiovascular mortality, as well as major morbidity, and 'late' cardiovascular mortality, major morbidity, structural and non-structural valve complications, quality of life and echocardiographic results. ETHICS AND DISSEMINATION The study protocol is approved by local ethics committees. Any formal presentation or publication of data will be considered as a joint publication by the participating physician(s) and will follow the recommendations of the International Committee of Medical Journal Editors for authorship. TRIAL REGISTRATION NUMBER NCT03143361; Pre-results.
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Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Riccardo Gherli
- Division of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Giovanni Mariscalco
- Department of Cardiovascular Surgery and Anesthesia and Critical Care of Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Eduardo Quintana
- Cardiovascular Surgery, Univeristy Hospital Clinic, Barcelona, Cataluna, Spain
| | | | - Marisa De Feo
- Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Piergiorgio Tozzi
- Cardiac Surgery Unit, Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mohamad Bashir
- Division of Cardiac Surgery, St. Barth Hospital NHS, London, UK
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | | | - Vito Giovanni Ruggieri
- Chirurgie Thoracique et Cardio-Vasculaire, Pole TCVN, Hopital Robert Debrè, Reims, France
| | - Giuseppe Santarpino
- Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Torino University Hospitals, Turin, Italy
| | - Silva Ronaldo
- Unit for Clinical Research and Biostatistics, Verona University Hospital, Verona, Italy
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Banovic MD, Nikolic SD. Treatment Strategies in Symptomatic Intermediate, Low-Risk, and Asymptomatic Patients With Severe Aortic Stenosis. Curr Probl Cardiol 2017; 43:335-354. [PMID: 29290389 DOI: 10.1016/j.cpcardiol.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Survival of symptomatic patients with severe aortic stenosis (AS) is very poor, with an average mortality reaching up to 2% per month. Approach to diagnosis and treatment of patients with AS was conservative; patients were referred to surgery only if the AS-induced symptoms become apparent and significantly limit the quality of patient' life. In the past 15 years, the novel treatment strategy in subgroups of symptomatic patients with AS have been the subject of extensive research, starting from introduction of transcatheter aortic valve implant (TAVI) in inoperable symptomatic patients with severe AS and continuing further to patients with very high and high operative risk. In the past few years, the focus has further shifted toward the patients with lower operative risk, as well as to asymptomatic patients with severe AS. In the former group, the question relates to whether TAVI is beneficial when compared to SAVR in intermediate- to low-risk patients with symptomatic AS. In the latter group, the main issue is if and when the SAVR should be performed. This article analyzes current status and evidences regarding treatment strategies in symptomatic high, intermediate, low-risk, and asymptomatic patients with isolated severe AS.
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Qureshi SH, Boulemden A, Szafranek A, Vohra H. Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2017; 53:463-471. [DOI: 10.1093/ejcts/ezx307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 11/14/2022] Open
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28
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Meco M, Miceli A, Montisci A, Donatelli F, Cirri S, Ferrarini M, Lio A, Glauber M. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: a meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg 2017; 26:202-209. [DOI: 10.1093/icvts/ivx294] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
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Matsuura K, Ueda H, Kohno H, Tamura Y, Watanabe M, Inui T, Inage Y, Yakita Y, Matsumiya G. Does the presence of coronary artery disease affect the outcome of aortic valve replacement? Heart Vessels 2017; 33:1-8. [PMID: 28744572 DOI: 10.1007/s00380-017-1024-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/21/2017] [Indexed: 08/30/2023]
Abstract
The purpose of this study is to compare the late outcome of aortic valve replacement with or without preoperative coronary artery disease, and with or without coronary artery bypass. Between 2014 and 2015, 291 patients underwent aortic valve replacement. Average follow-up term was 2.5 ± 2.2 years. The retrospective comparative study was performed between the patients with (n = 115) or without (n = 176) preoperative coronary artery disease (Study 1) and with (n = 93) or without (n = 198) coronary artery bypass grafting (Study 2). Study 1: male patients were more, and diabetes was more in the patients with coronary artery disease. Long-term survival rate was significantly low in the patients with coronary artery disease (p = 0.0002 by log rank test). Freedom from repeat coronary revascularization rate was lower in the patients with coronary artery disease (p = 0.02 by log rank test). Study 2: operation time (419 ± 130 vs 290 ± 101; p = 0.0001) was longer in the patients with coronary artery bypass grafting. Improvement of ejection fraction at follow-up was more in the patients with coronary artery bypass(114 ± 43 vs 104 ± 26%; p = 0.03). Long-term survival rate and freedom from major adverse cardiac event rater were not different with or without coronary artery bypass grafting (p = 0.26 and p = 0.59, respectively, by log rank test). Although prevalence of coronary artery disease inversely affected the long-term outcome of the aortic valve replacement, simultaneous coronary artery bypass did not. Aggressive simultaneous coronary revascularization would be important to improve the long-term outcome of aortic valve replacement.
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Affiliation(s)
- Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan.
| | - Hideki Ueda
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Hiroki Kohno
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Yusaku Tamura
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Tomohiko Inui
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Yuichi Inage
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Yasunori Yakita
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan
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Weymann A, Konertz J, Laule M, Stangl K, Dohmen PM. Are Sutureless Aortic Valves Suitable for Severe High-Risk Patients Suffering from Active Infective Aortic Valve Endocarditis? Med Sci Monit 2017; 23:2782-2787. [PMID: 28592789 PMCID: PMC5472401 DOI: 10.12659/msm.902785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Sutureless aortic valves were introduced to facilitate minimally invasive aortic valve surgery. Since sutureless aortic valves are a feasible procedure, we evaluated if any benefits could be identified in severe high-risk patients with active infective endocarditis of the aortic valve. Material/Methods Between April 2014 and April 2015, a total of 42 patients received a sutureless Perceval® aortic valve (Sorin Biomedica Cardio Srl, Saluggia, Italy) for different indications. Nine of these patients (median age 71 years, range 47–83 years) suffered from active infective endocarditis, including four patients with prosthetic aortic valve endocarditis. Five patients underwent prior cardiac surgery, including transcatheter aortic valve implantation (TAVI). The median EuroSCORE II was 29.5% (range 16.8–87.7%). Post-operatively, data regarding mortality, operative results, and early operative morbidity were collected. Results There were no cases of 30-day mortality. Four patients needed abscess closure with pericardium. Three patients underwent left atrial appendix closure: one left ventricular thrombectomy, one bypass grafting, and one arch replacement. Median aortic cross-clamp and cardiopulmonary bypass time was 35 minutes (range 26–88 minutes) and 52 minutes (range 40–133 minutes), respectively. The median intubation time was 14 hours (range 1–9 hours). In these high-risk patients, no postoperative morbidity was found except for one re-intubation due to extensive delirium and one re-exploration. No pacemaker implantation was needed. Echocardiographic evaluation showed no central or para-valvular regurgitation, and a median discharge mean gradient of 5.5 mm Hg (range 2.5–10.0 mm Hg). Conclusions Sutureless aortic valve replacement in very high-risk patients suffering from active infection endocarditis seems to be an option with limited morbidity and appropriate echocardiographic results, however, further studies are needed.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Johanna Konertz
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael Laule
- Department of Cardiology and Angiology, Charite Hospital, Medical University Berlin, Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charite Hospital, Medical University Berlin, Berlin, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Department of Cardiothoracic Surgery, Faculty of Health Science, Free State University, Bloemfontein, South Africa
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31
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Powell R, Pelletier MP, Chu MWA, Bouchard D, Melvin KN, Adams C. The Perceval Sutureless Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ramsey Powell
- Faculty of Medicine, Memorial University of Newfoundland, St. Johns, NL Canada
| | - Marc P. Pelletier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON Canada
| | - Denis Bouchard
- Department of Surgery, Montreal Heart Institute, Montreal, PQ Canada
| | - Kevin N. Melvin
- Division of Cardiac Surgery, Department of Surgery, Memorial University of Newfoundland, St. John's, NL Canada
| | - Corey Adams
- Division of Cardiac Surgery, Department of Surgery, Memorial University of Newfoundland, St. John's, NL Canada
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Bruno P, Di Cesare A, Nesta M, Cammertoni F, Mazza A, Paraggio L, Rosenhek R, Burzotta F, Crea F, Trani C, Massetti M. Rapid-deployment or transcatheter aortic valves in intermediate-risk patients? Asian Cardiovasc Thorac Ann 2017; 25:264-270. [PMID: 28361580 DOI: 10.1177/0218492317704773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Transcatheter aortic valve implantation and rapid-deployment aortic valve replacement represent two emerging therapies for patients with intermediate surgical risk and severe aortic stenosis. However, head-to-head comparisons between such novel therapies are lacking. Methods Severe aortic stenosis patients with intermediate surgical risk treated with rapid-deployment valve replacement at our institution were identified and compared with a propensity-matched population of patients who underwent transcatheter aortic valve replacement. Postoperative echocardiographic findings, in-hospital and midterm clinical outcomes were compared. Results We identified 60 patients who received transcatheter ( n = 30) or rapid-deployment ( n = 30) valve replacement. On postoperative echocardiography, freedom from paravalvular regurgitation was higher in the rapid-deployment valve group ( p < 0.001), while postoperative mean transprosthetic gradient was lower in the transcatheter valve group ( p = 0.03). Permanent pacemaker implantation was required more frequently in transcatheter valve patients ( p = 0.01). Postoperative atrial fibrillation was more common in the rapid-deployment valve group ( p = 0.03). Hospital mortality was similarly low in both groups ( p = 0.33). At midterm follow-up, mortality was comparable ( p = 0.42) but the rapid-deployment valve group still had a lower degree of paravalvular regurgitation. Conclusions Transcatheter and rapid-deployment valve replacement are promising treatment options for patients with intermediate surgical risk. These two techniques are associated with specific patterns of prosthesis function and postoperative complications. Further evaluation of the clinical impact of these therapies in this patient population is needed.
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Affiliation(s)
- Piergiorgio Bruno
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Di Cesare
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Mazza
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro Paraggio
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Raphael Rosenhek
- 2 Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Burzotta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Trani
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Massetti
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
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Takagi H, Ando T, Umemoto T. Direct and adjusted indirect comparisons of perioperative mortality after sutureless or rapid-deployment aortic valve replacement versus transcatheter aortic valve implantation. Int J Cardiol 2017; 228:327-334. [PMID: 27866023 DOI: 10.1016/j.ijcard.2016.11.253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine which procedure, aortic valve replacement (AVR) with a sutureless or rapid-deployment prosthesis (SL-AVR) or transcatheter aortic valve implantation (TAVI), achieves better perioperative survival for severe aortic stenosis (AS), we conducted direct-comparison meta-analyses (DC-MAs) and an adjusted indirect-comparison meta-analysis (IDC-MA). METHODS We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through April 2016. Eligible studies were randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. We performed a DC-MA-[A] of SL-AVR versus TAVI, a DC-MA-[B] of SL-AVR versus conventional AVR (C-AVR), and a DC-MA-[C] TAVI versus C-AVR. Then, we computed a IDC-MA-[A'] of TAVI versus SL-AVR from the results of the DC-MA-[B] and the DC-MA-[C]. RESULTS We identified 6 RCTs and 30 PSM studies enrolling a total of 15,887 patients. The 3 DC-MAs demonstrated significantly lower perioperative (30-day or in-hospital) all-cause mortality after SL-AVR than after TAVI (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28 to 0.80; p=0.005) and no significant differences between SL-AVR and C-AVR (OR, 1.07; 95% CI, 0.60 to 1.94; p=0.81) and between TAVI and C-AVR (1.07; 95% CI, 0.90 to 1.27; p=0.45). The computed IDC-MA-[A'] indicated no significant difference in mortality between SL-AVR and TAVI (1.01; 95% CI, 0.54 to 1.86). Combining the results of the DC-MA-[A] and IDC-MA [A'] showed significantly lower mortality after SL-AVR than after TAVI (OR, 0.65; 95% CI, 0.44 to 0.97; p=0.03). CONCLUSIONS For patients with severe AS, SL-AVR may achieve better perioperative survival than TAVI.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, United States
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Current Clinical Evidence on Rapid Deployment Aortic Valve Replacement: Sutureless Aortic Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:7-14. [PMID: 26918310 PMCID: PMC4791312 DOI: 10.1097/imi.0000000000000232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aortic stenosis is the most common valvular heart disease in the Western world. It is caused primarily by age-related degeneration and progressive calcification typically detected in patients 65 years and older. In patients presenting with symptoms of heart failure, the average survival rate is only 2 years without appropriate treatment. Approximately one half of all patients die within the first 2 to 3 years of symptom onset. In addition, the age of the patients presenting for aortic valve replacement (AVR) is increased along with the demographic changes. The Society of Thoracic Surgeons (STS) database shows that the number of patients older than 80 years has increased from 12% to 24% during the past 20 years. At the same time, the percentage of candidates requiring AVR as well as concomitant coronary bypass surgery has increased from 5% to 25%. Surgical AVR continues to be the criterion standard for treatment of aortic stenosis, improving survival and quality of life. Recent advances in prosthetic valve technology, such as transcatheter AVR, have expanded the indication for AVR to the extreme high-risk population, and the most recent surgical innovation, rapid deployment AVR, provides an additional tool to the surgeons’ armamentarium.
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Regeer M, Merkestein L, de Weger A, Kamperidis V, van der Kley F, van Rosendael P, Marsan N, Klautz R, Schalij M, Bax J, Delgado V. Left bundle branch block after sutureless, transcatheter, and stented biological aortic valve replacement for aortic stenosis. EUROINTERVENTION 2017; 12:1660-1666. [DOI: 10.4244/eij-d-15-00256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pfeiffer S, Fischlein T, Santarpino G. Sutureless Sorin Perceval Aortic Valve Implantation. Semin Thorac Cardiovasc Surg 2016; 29:1-7. [PMID: 28683983 DOI: 10.1053/j.semtcvs.2016.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 01/19/2023]
Abstract
The sutureless Perceval aortic valve (Sorin Group, Saluggia, Italy) is a device increasingly used in many European cardiac surgery centers. Since the first reports evaluating implantation feasibility and valve safety in humans in 2007, an increasing amount of data have become available, including premarketing clinical results and experience in particular conditions. Overall, excellent performances have been demonstrated in hemodynamic outcomes, safety, and versatility of use. However, several questions remain unanswered, especially regarding long-term durability, risk for endocarditis, and the need for postoperative pacemaker implantation. In this article, the most important studies published until now in the literature will be described, providing a state-of-the-art overview of current knowledge as well as future directions and indications for the use of the Perceval valve based on preliminary results of ongoing studies.
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Affiliation(s)
- Steffen Pfeiffer
- Cardiovascular Center, Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Theodor Fischlein
- Cardiovascular Center, Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Giuseppe Santarpino
- Cardiovascular Center, Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
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Rosato S, Santini F, Barbanti M, Biancari F, D'Errigo P, Onorati F, Tamburino C, Ranucci M, Covello RD, Santoro G, Grossi C, Ventura M, Fusco D, Seccareccia F. Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Low-Risk Patients. Circ Cardiovasc Interv 2016; 9:e003326. [PMID: 27154298 DOI: 10.1161/circinterventions.115.003326] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/15/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The proven efficacy of transcatheter aortic valve implantation (TAVI) in high-risk patients is leading to the expansion of its indications toward lower-risk patients. However, this shift is not supported by meaningful evidence of its benefit over surgical aortic valve replacement (SAVR). This analysis aims to describe outcomes of TAVI versus SAVR in low-risk patients. METHODS AND RESULTS We compared the outcome after TAVI and SAVR of low-risk patients (European System for Cardiac Operative Risk Evaluation II [EuroSCORE II] <4%) included in the Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment (OBSERVANT) study. The primary outcome was 3-year survival. Secondary outcomes were early events and major adverse cardiac and cerebrovascular events at 3 years. Propensity score matching resulted in 355 pairs of patients with similar baseline characteristics. Thirty-day survival was 97.1% after SAVR and 97.4% after TAVI (P=0.82). Cardiac tamponade, permanent pacemaker implantation, major vascular damage, and moderate-to-severe paravalvular regurgitation were significantly more frequent after TAVI compared with SAVR. Stroke rates were equal in the study groups. SAVR was associated with higher risk of cardiogenic shock, severe bleeding, and acute kidney injury. At 3 years, survival was 83.4% after SAVR and 72.0% after TAVI (P=0.0015), whereas freedom from major adverse cardiac and cerebrovascular events was 80.9% after SAVR and 67.3% after TAVI (P<0.001). CONCLUSIONS In patients with low operative risk, significantly better 3-year survival and freedom from major adverse cardiac and cerebrovascular events were observed after SAVR compared with TAVI. Further studies on new-generation valve prostheses are necessary before expanding indications of TAVI toward lower-risk patients.
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Affiliation(s)
- Stefano Rosato
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Francesco Santini
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Marco Barbanti
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Fausto Biancari
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Paola D'Errigo
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.).
| | - Francesco Onorati
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Corrado Tamburino
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Marco Ranucci
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Remo Daniel Covello
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Gennaro Santoro
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Claudio Grossi
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Martina Ventura
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Danilo Fusco
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
| | - Fulvia Seccareccia
- From the National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R., P.D., F. Seccareccia); Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy (F. Santini); Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., C.T.); Department of Surgery, Oulu University Hospital, Oulu, Finland (F.B.); Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy (F.O.); Department of Cardiothoracic and Vascular Anesthesia and ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (M.R.); Department of Anesthesia and Intensive Care, Ospedale di Busto Arsizio, Varese, Italy (R.D.C.); Division of Cardiology, Careggi Hospital, Florence, Italy (G.S.); Division of Cardiac Surgery, ASO S. Croce e Carle, Cuneo, Italy (C.G.); and Department of Epidemiology of Lazio Regional Health Service, Rome, Italy (M.V., D.F.)
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Wang N, Tsai YC, Niles N, Tchantchaleishvili V, Di Eusanio M, Yan TD, Phan K. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis 2016; 8:3283-3293. [PMID: 28066608 DOI: 10.21037/jtd.2016.11.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies. METHODS A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality. RESULTS Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVR patients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01). CONCLUSIONS The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
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Affiliation(s)
- Nelson Wang
- Department of Medicine, University of Sydney, Sydney, Australia
| | - Yi-Chin Tsai
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Natasha Niles
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | | | - Marco Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini' Hospital Piazza Italia, Teramo, Italy
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- Department of Medicine, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Vola M, Guichard JB, Campisi S, Fuzellier JF, Gerbay A, Doguet F, Isaaz K, Azarnoush K, Anselmi A, Ruggieri VG. Sutureless aortic bioprosthesis valve implantation and bicuspid valve anatomy: an unsolved dilemma? Heart Vessels 2016; 31:1783-1789. [PMID: 26758734 DOI: 10.1007/s00380-015-0790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/25/2015] [Indexed: 11/24/2022]
Abstract
Interest is growing in the clinical use of sutureless (SU) valves. However, indications in some anatomical sub-settings, like bicuspid aortic valves (BAV), have been so far limited. We discuss herein our initial experience with the implantation of the 3f Enable SU bioprosthesis in patients with a BAV. Patients with a BAV were selected in our unit between March 2011 and September 2014 for a SU 3f Enable valve implantation. Twenty of the 198 patients who underwent a 3f Enable valve implantation in our unit had a BAV. Procedural success was 100 %, but reclamping was necessary in one (5 %) case. Median size of implanted bioprosthesis was 23 mm. After a mean follow-up of 13.8 ± 10.7 months, survival was 100 %. Two patients (10 %) showed an immediate grade 1 paravalvular leak (PVL) that progressed to grade 2 and 3+ (moderate/severe), respectively, during follow-up. Type of bicuspidy (Sievers classification) in these two patients was 0 and intraoperatively aortic annuli admitted the 25 mm calibrator. Among the 18 patients without PVL, no one had a type 0 large BAV. At 1 year, implantation of the 3f Enable SU bioprosthesis appears to be safe in patients with BAV type I and II, while in type 0 use of the SU valve seems to be safe only if the annular diameter is <25 mm. Larger studies are necessary to confirm our findings in order to clarify the indications for SU technology in the subset of bicuspid patients.
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Affiliation(s)
- Marco Vola
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France. .,Service de Chirurgie Cardiovasculaire, Pôle Cardiovasculaire, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint-Etienne Cedex, France.
| | | | - Salvatore Campisi
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | | | - Antoine Gerbay
- Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Fabien Doguet
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Karl Isaaz
- Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Kasra Azarnoush
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Amedeo Anselmi
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Vito Giovani Ruggieri
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
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Toledano B, Bisbal F, Camara ML, Labata C, Berastegui E, Gálvez-Montón C, Villuendas R, Sarrias A, Oliveres T, Pereferrer D, Ruyra X, Bayés-Genís A. Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement. Interact Cardiovasc Thorac Surg 2016; 23:861-868. [DOI: 10.1093/icvts/ivw259] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 01/03/2023] Open
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Jung C, Lichtenauer M, Figulla HR, Wernly B, Goebel B, Foerster M, Edlinger C, Lauten A. Microparticles in patients undergoing transcatheter aortic valve implantation (TAVI). Heart Vessels 2016; 32:458-466. [PMID: 27488119 PMCID: PMC5371631 DOI: 10.1007/s00380-016-0885-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
Degenerative aortic stenosis (AS) is the most frequent form of acquired valvular heart disease. AS is known to entail endothelial dysfunction caused by increased mechanical shear stress leading to elevated circulatory levels of microparticles. Endothelial and platelet microparticles (EMP and PMP) are small vesicles that originate from activated cells and thrombocytes. We sought to evaluate whether transcatheter aortic valve implantation (TAVI) procedure would elicit effects on circulating EMP and PMP. 92 patients undergoing TAVI procedure for severe AS were included in this study. Samples were obtained at each visit before TAVI, 1 week post-procedure and at 1, 3 and after 6 months after TAVI and were evaluated using flow cytometry. A 12 month clinical follow-up was also performed. CD62E+ EMP concentration before TAVI was 21.11 % (±6.6 % SD) and declined to 20.99 % (±6.8 % SD) after 1 week, to 16.63 % (±5.4 % SD, p < 0.0001) after 1 month, to 17.08 % (±4.6 % SD, p < 0.0001) after 3 months and to 15.94 % (±5.4 % SD, p < 0.0001) after 6 months. CD31+/CD42b-, CD31+/Annexin+/- EMP remained unchanged. CD31+/CD41b+ PMP evidenced a slight, but statistically significant increase after TAVI and remained elevated during the entire follow-up. Apart from a procedure-related improvement in echocardiographic parameters, TAVI procedure led also to a decline in CD62E+ EMP. The reduction in pressure gradients with less hemodynamic shear stress seems also to have beneficially affected endothelial homeostasis.
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Affiliation(s)
- Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, University Duesseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany.
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Hans-Reiner Figulla
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bjoern Goebel
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Martin Foerster
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Christoph Edlinger
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Biancari F, D'Errigo P, Rosato S, Pol M, Tamburino C, Ranucci M, Seccareccia F. Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessels 2016; 32:157-165. [PMID: 27251569 DOI: 10.1007/s00380-016-0857-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/27/2016] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to evaluate the outcome of nonagenarians after transcatheter aortic valve replacement (TAVR) from the OBSERVANT study and to pool the results of the literature on this topic. Aortic stenosis is the most common acquired valvular heart disease in the Western countries, and its prevalence is linked to the phenomenon of population aging. TAVR can be considered as a wise approach to treat nonagenarians, but data on its safety and effectiveness are scarce. Data on 80 patients aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A systematic review and meta-analysis of published data were performed. Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these patients experienced stroke. Permanent pacemaker implantation was necessary in 20 % of patients. Paravalvular regurgitation was observed in 57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten series provided data on 1227 nonagenarians who underwent TAVR. Pooled 30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access complication 8.8 %, and permanent pacemaker implantation 10.6 %. Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-, 2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical TAVR was associated with a significantly higher risk of early mortality compared with transfemoral TAVR. The results of OBSERVANT study and aggregate data meta-analysis suggest that in nonagenarians, TAVR is associated with low postoperative morbidity and excellent intermediate survival. Transapical TAVR in these very elderly is associated with high postoperative mortality.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Paola D'Errigo
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy.
| | - Stefano Rosato
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy
| | - Marek Pol
- First Faculty of Medicine, Institute of Anatomy, Charles University in Prague, Prague, Czech Republic
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fulvia Seccareccia
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy
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Gallo M, Bonetti A, Poser H, Naso F, Bottio T, Bianco R, Paolin A, Franci P, Busetto R, Frigo AC, Buratto E, Spina M, Marchini M, Ortolani F, Iop L, Gerosa G. Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts. Heart Vessels 2016; 31:1862-1873. [PMID: 27115146 DOI: 10.1007/s00380-016-0839-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/15/2016] [Indexed: 12/30/2022]
Abstract
Decellularized porcine aortic valve conduits (AVCs) implanted in a Vietnamese Pig (VP) experimental animal model were matched against decellularized and then cryopreserved AVCs to assess the effect of cryopreservation on graft hemodynamic performance and propensity to in vivo repopulation by host's cells. VPs (n = 12) underwent right ventricular outflow tract substitution using AVC allografts and were studied for 15-month follow-up. VPs were randomized into two groups, receiving AVCs treated with decellularization alone (D; n = 6) or decellularization/cryopreservation (DC; n = 6), respectively. Serial echocardiography was carried out to follow up hemodynamic function. All explanted AVCs were processed for light and electron microscopy. No signs of dilatation, progressive stenosis, regurgitation, and macroscopic calcification were echocardiographically observed in both D and DC groups. Explanted D grafts exhibited near-normal features, whereas the presence of calcification, inflammatory infiltrates, and disarray of elastic lamellae occurred in some DC grafts. In the unaltered regions of AVCs from both groups, almost complete re-endothelialization was observed for both valve cusps and aorta walls. In addition, side-by-side repopulation by recipient's fibroblasts, myofibroblasts, and smooth muscle cells was paralleled by ongoing tissue remodeling, as revealed by the ultrastructural identification of typical canals of collagen fibrillogenesis and elastogenesis-related features. Incipient neo-vascularization and re-innervation of medial and adventitial tunicae of grafted aortic walls were also detected for both D and DC groups. Cryopreservation did not affect post-implantation AVC hemodynamic behavior and was topically propensive to cell repopulation and tissue renewal, although graft deterioration including calcification was present in several areas. Thus, these preliminary data provide essential information on feasibility of decellularization and cryopreservation coupling in the perspective of treatment optimization and subsequent clinical trials using similarly treated human allografts as innovative heart valve substitutes.
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Affiliation(s)
- Michele Gallo
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
| | - Antonella Bonetti
- Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Helen Poser
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Filippo Naso
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Tomaso Bottio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Roberto Bianco
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Adolfo Paolin
- Tissue Bank of Veneto Region, Treviso Regional Hospital, Treviso, Italy
| | - Paolo Franci
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Roberto Busetto
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padua, Padua, Italy
| | - Edward Buratto
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Michele Spina
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Maurizio Marchini
- Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Fulvia Ortolani
- Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Laura Iop
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Cardiovascular Regenerative Medicine, Venetian Institute of Molecular Medicine (VIMM), Biomedical Campus Pietro d'Abano, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,Cardiovascular Regenerative Medicine, Venetian Institute of Molecular Medicine (VIMM), Biomedical Campus Pietro d'Abano, Padua, Italy
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Cappabianca G, Ferrarese S, Musazzi A, Terrieri F, Corazzari C, Matteucci M, Beghi C. Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up. Heart Vessels 2016; 31:1798-1805. [PMID: 26843194 DOI: 10.1007/s00380-016-0804-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/22/2016] [Indexed: 11/27/2022]
Abstract
The improvement of life expectancy created more surgical candidates with severe symptomatic aortic stenosis and age >80. Therefore, the main objective of this observational, retrospective single-centre study is to compare the long-term survival of octogenarians that have undergone surgical aortic valve replacement (AVR) to the survival of the general population of the same age and to establish whether any perioperative characteristics can anticipate a poor long-term result, limiting the prognostic advantage of the procedure at this age. From 2000 to 2014, 264 octogenarians underwent AVR at our institution. Perioperative data were retrieved from our institutional database and patients were followed up by telephonic interviews. The follow-up ranged between 2 months and 14.9 years (mean 4.1 ± 3.1 years) and the completeness was 99.2 %. Logistic multivariate analysis and Cox regression were respectively applied to identify the risk factors of in-hospital mortality and follow-up survival. Our patient population ages ranged between 80 and 88 years. Isolated AVR (I-AVR) was performed in 136 patients (51.5 %) whereas combined AVR (C-AVR) in 128 patients (48.5 %). Elective procedures were 93.1 %. Logistic EuroSCORE was 15.4 ± 10.6. In-hospital mortality was 4.5 %. Predictive factors of in-hospital mortality were the non-elective priority of the procedure (OR 5.7, CI 1.28-25.7, p = 0.02), cardiopulmonary bypass time (OR 1.02, CI 1.01-1.03, p = 0.004) and age (OR 1.36, CI 1.01-1.84, p = 0.04). Follow-up survival at 1, 4, 8 and 12 years was 93.4 % ± 1.6 %, 72.1 % ± 3.3 %, 39.1 % ± 4.8 % and 20.1 % ± 5.7 %, respectively. The long-term survival of these patients was not statistically different from the survival of an age/gender-matched general population living in the same geographic region (p = 0.52). Predictive factors of poor long-term survival were diabetes mellitus (HR 1.55, CI 1.01-2.46, p = 0.05), preoperative creatinine >200 μmol/L (HR 2.07, CI 1.21-3.53, p = 0.007) and preoperative atrial fibrillation (HR 1.79, CI 1.14-2.80, p = 0.01). In our experience, AVR can be safely performed in octogenarians. After a successful operation, the survival of these patients returns similar to the general population. Nevertheless, the preoperative presence of major comorbidities such as diabetes mellitus, renal dysfunction and atrial fibrillation significantly impact on long-term results.
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Affiliation(s)
- Giangiuseppe Cappabianca
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Andrea Musazzi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Francesco Terrieri
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Claudio Corazzari
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Cesare Beghi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
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Gomes WJ, Leal JC, Jatene FB, Hossne NA, Gabaldi R, Frazzato GB, Agreli G, Braile DM. Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis. Braz J Cardiovasc Surg 2016; 30:515-9. [PMID: 26735597 PMCID: PMC4690655 DOI: 10.5935/1678-9741.20150072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/02/2015] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The conventional aortic valve replacement is the treatment of choice for
symptomatic severe aortic stenosis. Transcatheter technique is a viable
alternative with promising results for inoperable patients. Sutureless
bioprostheses have shown benefits in high-risk patients, such as reduction
of aortic clamping and cardiopulmonary bypass, decreasing risks and adverse
effects. OBJECTIVE The objective of this study was to experimentally evaluate the implantation
of a novel balloon-expandable aortic valve with sutureless bioprosthesis in
sheep and report the early clinical application. METHODS The bioprosthesis is made of a metal frame and bovine pericardium leaflets,
encapsulated in a catheter. The animals underwent left thoracotomy and the
cardiopulmonary bypass was established. The sutureless bioprosthesis was
deployed to the aortic valve, with 1/3 of the structure on the left
ventricular face. Cardiopulmonary bypass, aortic clamping and deployment
times were recorded. Echocardiograms were performed before, during and after
the surgery. The bioprosthesis was initially implanted in an 85 year-old
patient with aortic stenosis and high risk for conventional surgery,
EuroSCORE 40 and multiple comorbidities. RESULTS The sutureless bioprosthesis was rapidly deployed (50-170 seconds; average=95
seconds). The aortic clamping time ranged from 6-10 minutes, average of 7
minutes; the mean cardiopulmonary bypass time was 71 minutes. Bioprostheses
were properly positioned without perivalvar leak. In the first operated
patient the aortic clamp time was 39 minutes and the patient had good
postoperative course. CONCLUSION The deployment of the sutureless bioprosthesis was safe and effective,
thereby representing a new alternative to conventional surgery or
transcatheter in moderate- to high-risk patients with severe aortic
stenosis.
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Affiliation(s)
- Walter J Gomes
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - João Carlos Leal
- Sociedade Portuguesa de Beneficência de São José do Rio Preto, SP, Brazil
| | - Fabio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nelson A Hossne
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Domingo M Braile
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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